Breast Augmentation (Breast Implants or Fat Transfer) in Boston
Joan Rivers wrote a wonderful book titled: MEN ARE STUPID…AND THEY LIKE BIG BOOBS. If you haven’t read the book yet, consider picking up a copy or browsing through a copy in our office. It’s not only hilarious, it also offers great insight into plastic surgery and cosmetic surgery operations with her “straight-talking advice on cosmetic surgery, and better living through looking better.”
Breast augmentation is the most popular cosmetic operation performed by top board certified plastic surgeons because, as Joan Rivers notes, “breasts make the world go round.” Breast augmentation is for a woman who feels that her breast size or shape is not in harmony with her body or for a woman who desires more breast fullness. Breast implants can create natural appearing and natural feeling breasts to rejuvenate volume loss from aging, pregnancy, breast feeding, or weight loss - perhaps your tummy and bum look great from your Peloton classes…..but your breasts have deflated. Other common reasons for breast augmentation are to make the breasts more proportionate with the body, to feel more attractive, or to make breasts more perky. All patients have some asymmetry between breasts, and breast augmentation provides an opportunity to improve symmetry. Some women may also want a breast lift if your breasts have fallen or sag and developed breast “ptosis”. A breast lift (mastopexy) can be performed at the same time as a breast augmentation or as a separate operation. Fat grafting or fat transfer can also complement breast augmentation or breast lift.
Selecting a Breast Implant Size
Selecting a breast implant is a blend of science and art, and Dr. Taylor and Dr. Sullivan work closely with each patient to make decisions together. Their recommendations for a breast implant size, fill, surface, shape, and style will be based on careful breast measurements, assessment of breast shape, skin quality, each patient's proportions, and patient preferences. Breast implant size is referred to as the number of cubic centimeters or "cc's", which measures the exact size or how much volume is in the breast implant. One cc is approximately one gram. In general, some may consider 200 cc to be approximately one cup size in a bra. A “bra size” or “cup size”, however, is used by department stores or clothing companies and is not objective, as cup size changes with every store or brand. A “34 C” at Nordstrom or Athleta will likely be a much different size than the “34 C” at Victoria’s Secret, depending on whether the store wants you to feel like your breasts are smaller or larger than they actually are. If you don’t like the size written on the label of your bra, cut out the label or try a different department store. In our office, patients will be able to see and feel samples of breast implants of various sizes to understand cc's and breast size.
Silicone or Saline Breast Implants
Breast implants can be filled with either silicone or saline (salt water) - either way, the outer shell is made of silicone. Silicone is made from silicon, a naturally occurring element. Because of its safety, silicone is used in many medical devices and surgical implants. Silicone breast implants are a soft cohesive gel with a natural feeling. The cohesiveness of the gel and the fullness of the implant can be selected. Patients must be at least 22 years old to have silicone gel breast implants. Patients younger than 22 years of age may qualify for silcone implants if they have chest deformities or congenital breast asymmetry. The surface of breast implants can be smooth or textured. Smooth implants are more commonly used and we, along with many surgeons, have moved away from using textured implants and don’t recommend them. Breast implants can be round or teardrop shaped. Round implants may provide more fullness of the upper breast while shaped implants may provide more fullness of the lower breast. Round implants are more common, and when a woman is standing, round implants have a shape similar to shaped implants while having the advantage of softer less rigid gel.
Breast Implant Approach and Scar
The location of incisions will also be considered during your evaluation and the decision will be based on what is best for you, and each individual patient. An inframammary incision (placed under the breast in the fold where the breast meets the chest) is the most common approach as the scar can be relatively hidden, heals well, and provides excellent access for proper breast implant placement without exposure to breast ducts and bacteria. The incision will approximately 3 to 4 cm (less than 2 inches) in length, depending on the size of the breast implant. Dr. Taylor and Dr. Sullivan use all buried sutures to close the incision so there are no stitches to remove and no drainage tubes are used. The incision is sealed with surgical glue and a sticker so you don’t have to do anything for wound care and you can shower and wash your breasts the next day. The scar will be slightly red for several weeks to months and eventually usually fades to a pale color and is hidden under the breast. Another common, though less frequent approach is known as “periareolar” or at the edge of the darker tissue around the nipple. When this approach is used, the incision is usually placed on the lower half of the areola at the junction of the areola and the breast skin to hide the scar. The periareolar approach requires dissection through the breast and may expose the implant to more bacteria and risk for infection. The transaxillary approach or through the armpit can also be used, though this approach may have a higher risk of implant malposition, swelling of arms if lymphatic channels are disrupted, and decreased sensation on the upper arms if nerves are disrupted.
Breast Implant Placement and Location
Breast implants can be placed under the breast tissue (subglandular) or under the pectoralis muscle (submuscular, subpectoral, or "dual plane"). Dr. Taylor and Dr. Sullivan can review some of the advantages and disadvantages to each breast implant location. To reduce the risk of complications such as infection or implant damage and to maximize safety and efficiency during the operation, Dr. Taylor and Dr. Sullivan may use the Keller Funnel to insert breast implants. This innovation allows a limited or "no-touch" technique to safely insert breast implants through a smaller incision and may reduce risks of infection or breast implant associated lymphoma (BIA-ALCL).
Minimize pain and Discomfort with Breast Augmentation
Most important is to work with a surgeon with whom you feel comfortable and safe. Dr. Taylor and Dr. Sullivan, both certified by the American Board of Plastic Surgery and named among the “Best Plastic Surgeons” by Boston Magazine, will spend time with you to carefully select an implant type and size as well as surgical approach for breast enhancement. With their carefully planned protocols, patient safety is the highest priority and patients can often avoid taking or reduce postoperative opioid or narcotic pain medications. Dr. Taylor and Dr. Sullivan are among very few plastic surgeons in the Boston area to use the latest and most effective medications for pain control, including Exparel (liposomal bupivacaine). Operations are performed at Mount Auburn Hospital, a Harvard teaching hospital in Cambridge, Massachusetts. The operation usually takes Dr. Sullivan and Dr. Taylor about 50 minutes. They often operate together as a two physician team to provide complementary perspectives and the best possible outcome. Patients may have sedation with local anesthesia or general anesthesia for safety and comfort. Patients recover quickly from the procedure and return home on the same day.
BREAST AUGMENTATION (Breast Implant) AFTERCARE INSTRUCTIONS
• In the week before your operation:
o Consider eating pineapple, it may help reduce bruising
o Consider supplementing with Arnica montana, it may help reduce bruising
o Complete household chores and prepare meals for the first few days of postoperative recovery
o Follow preoperative instructions with eating, drinking, and medications
• Postoperatively, get out of bed and walk (with assistance) every few hours after your operation to decrease the chance of postoperative problems such as blood clots.
• Practice 15-20 deep breaths every hour to keep your lungs open.
• After surgery, it is important for you to have someone available to stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.
• Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.
o Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours
o Ibuprofen (Motrin) 800 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours
o Gabapentin 300 mg every 8 hours for 7 days
o Vitamin C 500 mg daily for 50 days
o Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it
o Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day
o Zofran 8 mg every 8 hours if needed for nausea
o Scopolamine patch will be placed behind the ear on the day of surgery and can stay for 3 days
• Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:
o Drink water or warm liquids
o Prune juice to prevent constipation
• You may shower or sponge bath the day after the operation with assistance and wash your skin as you normally would with soap and water. Avoid soaking the incision, although It will not hurt to get a splash of water on the wounds. Gently pat dry after washing.
• You may wear a camisole, postoperative bra provided at the hospital, or no bra after surgery. Dr. Taylor or Dr. Sullivan will advise you when you may wear an underwire bra - usually 6 weeks after surgery.
• Most wounds will be closed with absorbable sutures that are buried, skin glue, and a transparent dressing. The dressing forms a sterile barrier. Please do not remove the dressing, it will fall off on its own after a few weeks. Do not apply any lotions, potions, ointments, creams or solutions (e.g. no hydrogen peroxide or alcohol) as they can be harmful to the fragile healing tissue.
• Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.
• Infection is uncommon, though please call Dr. Taylor or Dr. Sullivan immediately at any sign of infection which would be signaled by fever, increased pain, new redness or swelling in breast area.
• For the first few days following surgery, avoid raising your blood pressure or heart rate as it can cause bleeding. We recommend gentle range of motion exercises with your arms 3 to 5 times per day starting the day of the operation.
• Please do not drive until turning the steering wheel can be done safely and without pain (usually 5 to 7 days). Do not drive while taking pain medications such as oxycodone.
• Do not perform chest muscle exercises or strenuous bouncing exercises for 6 weeks.
• Breast implant massage should start 5 to 7 days after surgery and be performed 3 to 5 times each day. Dr. Taylor or Dr. Sullivan will show you how to perform these breast exercises, which may help to prevent capsular contractures, promote healing of the chest muscles, and slowly position the breast implants. The scars can be massaged starting 3 weeks after surgery. This may promote early softening and maturation of these areas.
• Moderate swelling of your breasts is to be expected, the breast implants may seem too high, and the skin may feel tight. It is normal for implants to “ride high” for 3 to 4 weeks after an operation. The upper portion of your breasts may also look square, which is swelling of the breast and pectoralis muscle. The incision under the breast may also look “stuck down” or sunken compared to the surrounding skin. Please be patient, this is normal and intentional to give you the best long-term outcome from your operation and to decrease the chance that the breast implant will “bottom out” or slide down.
• The swelling and feeling of tightness will gradually subside over the following 4 to 6 weeks and the implants will settle into position for approximately 12 to 16 weeks. The scar under the breast will also slowly release and look less “stuck down” over the same 12 to 16 week time period. Please wait 12 weeks to buy new bras to ensure proper sizing.
• Sensations like numbness, shooting pain, and burning are common during the healing process, may last several weeks, and gradually disappear. If the nipples are sensitive, it is best to desensitize them with gentle touch.
• Scars take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is not worth the expense. All incisions will be sensitive to sunlight during the healing phase. Direct sun contact or tanning booths are to be avoided. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.
• A small amount bleeding from the incision is expected. Please call our office (617-492-0620) if you have:
o Continuous bleeding
o Significantly more swelling on one side when compared to the other
o Worsening pain
o Fever, spreading redness or irritation of the skin
o Shortness of breath
It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year or as often as needed post-op. Call to schedule your appointments at Taylor & Sullivan Plastic Surgery office at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.